Prevalence of Oxacillin-resistant Staphylococcus Strains in Clinical Specimens from Intensive Care Unit Patients

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Νebulised colistin for ventilator-associated pneumonia prevention

We assessed if prophylactic nebulised colistin might reduce ventilator-associatedpneumonia (VAP) incidence in a setting, mixed medical-surgical ICU, where multidrug-resistant (MDR) bacteria were prevalent and endemic.We used a single-centre, two-arm, randomised, open-label, controlled trial in a 12-bed ICU in the University Hospital of Larissa, Greece. Patient inclusion criteria included mechanical ventilation of >48 h.The two arms consisted of prophylaxis with 500000 U colistin (Col group) or normal saline (NS group), thrice daily, for the first 10 ICU days or until extubation. The primary outcome of the study was the 30-day VAP incidence.In total, 168 patients entered the study. VAP incidence was not different between Col and NS group patients (14 (16.7%) versus 25 (29.8%), respectively, p=0.07). Regarding the secondary outcomes, the intervention resulted in a lower VAP incidence density rate (11.4 versus 25.6, respectively, p 48 ωρών. 168 ασθενείς έλαβαν μέρος στην παρούσα μη τυφλή, τυχαιοποιημένη μελέτη που έλαβε χώρα στη ΜΕΘ του Πανεπιστημιακού Νοσοκομείου Λάρισας, δύναμης 12 κλινών. Οι ασθενείς χωρίστηκαν σε δύο ομάδες: 84 έλαβαν 500000 μονάδες κολιμυκίνης και 84 φυσιολογικό ορό. Ως κύρια έκβαση ορίστηκε η επίπτωση της VAP στις 30 μέρες. Η επίπτωση της VAP δε διέφερε μεταξύ των ομάδων (14 (16.7%) στην ομάδα παρέμβασης έναντι 25 (29.8%) στην ομάδα ελέγχου (p=0.07). Ως προς τις δευτερεύουσες εκβάσεις, η VAP από πολυανθεκτικά μικρόβια και από Gram αρνητικά μικρόβια βρέθηκαν ελαττωμένες. Παράλληλα, δεν παρατηρήθηκε κατά τη διάρκεια της μελέτης ανάπτυξη μικροβιακής αντοχής, στην κολιμυκίνη ή περαιτέρω πολυαντοχή. Τα ευρήματά μας δε δείχνουν σημαντική ελάττωση της επίπτωσης της VAP από την προφυλακτική χορήγηση κολιστίνης

Community-Associated Staphylococcus aureus Infections: Pneumonia

Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) is an emerging health problem with distinct epidemiology. CA-MRSA colonization and infection is associated with risk factors different from healthcare-associated methicillin-resistant S. aureus infection. CA-MRSA strains pre­sent different characteristics to healthcare associated strains in terms of microbiology as well. Moreover, infection as a result of CA-MRSA may be associated with severe infections, in particular necrotizing pneumonia. CA-MRSA strains may produce Panton-Valentine leukocidin, a protein that available data suggest to be associated with the severity of the infection. Although the incidence of CA-MRSA pneumonia is relatively low, it affects mostly young, immunocompetent individuals, and in this respect constitutes a serious and potentially lethal form of community-acquired pneumonia. Current treatment suggested by international consensus guidelines includes linezolid or vancomycin often combined with clindamycin and/or rifampicin. However, clinical studies are required to clarify further therapeutic issues on timing, dosing, and choice of optimum treatment, and whether new therapeutic strategies such as vaccination and immunoglobulins could be useful. In the present review we discuss the microbiology, epidemiology, pathogenesis, and clinical aspects of community-acquired pneumonia as a result of CA-MRSA in respect of management and prevention

Severe Candida infections in critically ill patients with COVID-19

The frequency of co-infections with bacterial or fungal pathogens has constantly increased among critically ill patients with coronavirus disease 2019 (COVID-19) during the pandemic. Candidemia was the most frequently reported invasive fungal co-infection. The onset of candidemia in COVID-19 patients was often delayed compared to non-COVID-19 patients. Additionally, Candida invasive infections in COVID-19 patients were more often linked to invasive procedures (e.g., invasive mechanical ventilation or renal replacement therapy) during the intensive care stay and the severity of illness rather than more “classic” risk factors present in patients without COVID-19 (e.g., underlying diseases and prior hospitalization). Moreover, apart from the increased incidence of candidemia during the pandemic, a worrying rise in fluconazole-resistant strains was reported, including a rise in the multidrug-resistant Candida auris. Regarding outcomes, the development of invasive Candida co-infection had a negative impact, increasing morbidity and mortality compared to non-co-infected COVID-19 patients. In this narrative review, we present and critically discuss information on the diagnosis and management of invasive fungal infections caused by Candida spp. in critically ill COVID-19 patients

Novel Antimicrobial Agents for Gram-Negative Pathogens

Gram-negative bacterial resistance to antimicrobials has had an exponential increase at a global level during the last decades and represent an everyday challenge, especially for the hospital practice of our era. Concerted efforts from the researchers and the industry have recently provided several novel promising antimicrobials, resilient to various bacterial resistance mechanisms. There are new antimicrobials that became commercially available during the last five years, namely, cefiderocol, imipenem-cilastatin-relebactam, eravacycline, omadacycline, and plazomicin. Furthermore, other agents are in advanced development, having reached phase 3 clinical trials, namely, aztreonam-avibactam, cefepime-enmetazobactam, cefepime-taniborbactam, cefepime-zidebactam, sulopenem, tebipenem, and benapenem. In this present review, we critically discuss the characteristics of the above-mentioned antimicrobials, their pharmacokinetic/pharmacodynamic properties and the current clinical data

Severe Candida infections in critically ill patients with COVID-19

The frequency of co-infections with bacterial or fungal pathogens has constantly increased among critically ill patients with coronavirus disease 2019 (COVID-19) during the pandemic. Candidemia was the most frequently reported invasive fungal co-infection. The onset of candidemia in COVID-19 patients was often delayed compared to non-COVID-19 patients. Additionally, Candida invasive infections in COVID-19 patients were more often linked to invasive procedures (e.g., invasive mechanical ventilation or renal replacement therapy) during the intensive care stay and the severity of illness rather than more “classic” risk factors present in patients without COVID-19 (e.g., underlying diseases and prior hospitalization). Moreover, apart from the increased incidence of candidemia during the pandemic, a worrying rise in fluconazole-resistant strains was reported, including a rise in the multidrug-resistant Candida auris. Regarding outcomes, the development of invasive Candida co-infection had a negative impact, increasing morbidity and mortality compared to non-co-infected COVID-19 patients. In this narrative review, we present and critically discuss information on the diagnosis and management of invasive fungal infections caused by Candida spp. in critically ill COVID-19 patients

Ventilator-Associated Tracheobronchitis Increases the Length of Intensive Care Unit Stay

OBJECTIVE. To investigate prospectively the clinical course and risk factors for ventilator-associated tracheobronchitis (VAT) and the impact of VAT on intensive care unit (ICU) morbidity and mortality. DESIGN. Prospective cohort study. SETTING. University Hospital Larissa, Larissa, Greece PATIENTS. Critical care patients who received mechanical ventilation for more than 48 hours were prospectively studied between 2009 and 2011. METHODS. The modified Clinical Pulmonary Infection Score, white blood cell count, and C-reactive protein level were systematically assessed every 2 days for the first 2 weeks of ICU stay. Bronchial secretions were assessed daily. Quantitative cultures of endotracheal secretions were performed on the first ICU day for every patient and every 2 days thereafter for the first 2 weeks or more at the discretion of the attending physicians. Definition of VAT was based on previously published criteria. RESULTS. A total of 236 patients were observed; 42 patients (18%) presented with VAT. Gram-negative pathogens, which were usually multidrug resistant, were responsible for 92.9% of cases. Patients with a neurosurgical admission presented with VAT significantly more often than did other ICU patients (28.5% vs 14.1%; P = .02). The occurrence of VAT was a significant risk factor for increased duration of ICU stay (OR [95% CI], 3.04 [1.35-6.85]; P = . 01). Age (OR [95% CI], 1.04 [1.015-1.06]; P = .02), Acute Physiology and Chronic Health Evaluation II score (OR [95% CI], 1.08 [1.015-1.16]; P = .02), and C-reactive protein level at admission (OR [95% CI], 1.05 [1.01-1.1]; P = .02) were independent factors for ICU mortality. CONCLUSIONS. VAT is a nosocomial infection that might be associated with prolonged stay in the ICU, especially in neurocritical patients. VAT was not associated with increased mortality in our study

Severe mold fungal infections in critically ill patients with COVID-19

The SARS-CoV-2 pandemic put an unprecedented strain on modern societies and healthcare systems. A significantly higher incidence of invasive fungal co-infections was noted compared with the pre-COVID-19 era, adding new diagnostic and therapeutic challenges in the critical care setting. In the current narrative review, we focus on invasive mold infections caused by Aspergillus and Mucor species in critically ill COVID-19 patients. We discuss up-to-date information on the incidence, pathogenesis, diagnosis and treatment of these mold-COVID-19 co-infections, as well as recommendations on preventive and prophylactic interventions. Traditional risk factors were often not recognized in COVID-19-associated aspergillosis and mucormycosis, highlighting the role of other determinant risk factors. The associated patient outcomes were worse compared with COVID-19 patients without mold co-infection